Is 'Sinus' pain really sinusitis? Agius AM, Jones NS, Muscat R. Br J Hosp Med 2014; 75 (10): 696-701

Abstract

So-called ‘sinus pain’ is a common complaint in GP and ENT clinics, and patients often receive treatment with antibiotics and decongestants. Recent evidence suggests however that facial pain may not be related to the sinuses at all and that doctors may have to rethink their prescribing strategy.

This article reviews present knowledge regarding the aetiology, characteristics, course and treatment of chronic, recurring pain in the mid-face, often referred to as ‘sinus pain’ by patients and doctors alike. This common symptom is frequently diagnosed as chronic sinusitis and tends to recur following medical treatment or sinus surgery. Long-term patient follow-up and clinical trials have enabled otolaryngologists to point to a neurological cause. As a result, current concepts of treatment are being revised in the medical and surgical approach to facial pain. This article explains how to diagnose and manage the common types of chronic facial pain.

 

Agius AM, Jones NS, Muscat R. Is ‘sinus’ pain really sinusitis? Br J Hosp Med 2014; 75 (10): 696-701

So-called ‘sinus pain’ is a common complaint in GP and ear, nose and throat clinics, and patients often receive treatment with antibiotics and decongestants. Recent evidence suggests that facial pain may not be related to the sinuses at all and that doctors may have to rethink their prescribing strategy.

 
Agius AM, Sama A. Rhinogenic and nonrhinogenic headaches. Curr Opin Otolaryngol Head Neck Surg 2015, 23: 15-20

This article reviews present knowledge and recent publications on the aetiology, characteristics, course and treatment of chronic and recurring facial pain and headaches. Facial pain is amongst the commonest complaints in ENT clinics. Recent articles have presented important evidence based approach to this common problem.

Recent findings

Recent publications in the fields of otolaryngology and neurology have better defined the differences between rhinogenic and non-rhinogenic facial pain, and places this symptom in the context of rhinosinusitis. Although chronic facial pain has conventionally been considered to be due sinusitis because of anatomical proximity, there is increasing evidence to support to the contrary. Published literature has identified that only 16-20% of patients with sinusitis (purulent or with polyposis) confirmed by nasal endoscopy actually declared symptoms of facial pain. More pertinently, surgical series have shown that up to 40% of patients hadpersistentpostoperativefacialpaindespiteresolutionofsinusitisonnasalendoscopyandCT. Rhinogenic pain is generally unilateral, severe, located on the same side, and related to rhinogenic symptoms and almost always accompanied by endoscopic and CT abnormalities. Incidental CT mucosal disease can be noted in 30%ofasymptomaticpatients.

Summary

Traditionally facial pain has often been considered to be caused by chronic rhinosinusitis (CRS). Increasing evidence has shown that commonest cause for chronic facial pain is of non-rhinogenic origin. As Otorhinolaryngologists, we deal with facial pain on a daily basis and therefore need to be aware of the different causes for this common symptom.

 
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